II. Definitions
- Blood Product
- Native blood component acquired from a donor, that is processed for transfusion into a recipient
- Includes Packed Red Blood Cells (pRBC), Fresh Frozen Plasma (FFP), Platelets and Cryoprecipitate
III. Epidemiology
-
Prevalence in U.S.
- More than 16 million units of Blood Product are transfused every year in the United States
IV. Types: Blood Product Modifications
- Background
- Modifications to Blood Products reduce complications, esp. in those patients at risk
- CMV Risk Reduction
- Indicated in pregnancy and severe Immunocompromised states
- Limits donors to CMV negative or supplies Leukocyte reduced blood
-
Hemoglobin-S Negative Blood Products
- Indicated in Sickle Cell Anemia patients
- Limits donors to non-sickling Hemoglobin
- Irradiation
- Indicated in severe Immunocompromised states
- Indicated in Hematologic Malignancy, Bone Marrow Transplant, inherited cellular immune deficiency
- NOT indicated in HIV, Sepsis, Solid Organ Transplant or solid metastatic cancer
- Prevents T Lymphocytes from replicating
- Prevents Transfusion Associated Graft Versus Host Disease (TAGVHD)
- Indicated in severe Immunocompromised states
-
Leukocyte Reduction (Leukoreduction)
- Reduces Leukocyte concentration in Blood Products (pRBC, Platelet Transfusion)
- Typically standard for Red Blood Cell Transfusions to be Leukocyte reduced
- Decreases risk of Febrile Nonhemolytic Transfusion Reaction (FNHTR)
- Decreases risk of CMV Infection
- Pathogen Inactivation
- UV-Light mediated destruction of pathogens with Nucleic Acids (does not replace other donor screening methods)
- Similar results to Irradiation
- Pathogen Inactivation is only available for Plasma Transfusion and Platelet Transfusion
- Volume Reduction
- Acellular fluid reduced (concentrating Blood Product)
- Decreased risk of several Transfusion Complications
- However, volume reduction has downsides (similar to washing)
- Decreases Blood Product shelf-life
- Requires increased blood bank staff time for processing
- Washing
- Replaces non-cellular fluid in cellular Blood Products
- Indicated in history of severe Allergic Transfusion Reaction or IgA deficiency
- Also indicated to sensitivity to extracellular Hemoglobin or Potassium
- Decreased risk of several Transfusion Complications
- However, washing has significant downsides
- Decreases Blood Product shelf-life (activates Platelets, hemolyzes Red Blood Cells)
- Requires increased blood bank staff time for processing
V. Types: Packed Red Blood Cells (pRBC)
- See Blood Transfusion (pRBC, Packed Red Blood Cells)
- Contains 200-250 ml per unit pRBC
- Increases Hematocrit 3% per unit pRBC
- Increases Hemoglobin 1 gram/dl per unit pRBC
- Indication
- Hemorrhagic Shock
- Hypovolemic Shock despite 40 ml/kg crystalloid
- Hemoglobin <7 to 8 g/dl
- Coagulopathy
VI. Types: Fresh Frozen Plasma (FFP)
- See Plasma Transfusion (Fresh Frozen Plasma, FFP)
- Contains 200-250 ml per unit
- Contains all Clotting Factors
- Does not contain Platelets
- Dosing: 10-20 ml/kg
- Increases Fibrinogen 7-10 mg/dl per unit
- Prothrombin Complex Concentrate (PCC4) has largely replaced FFP for Warfarin Emergent Reversal of Anticoagulation
- Indications
- INR >1.5 to 1.6 AND
- Active bleeding or high risk of bleeding
VII. Types: Cryoprecipitate
- See Cryoprecipitate
- See Prothrombin Complex Concentrate (PCC4)
- Contains 50 ml/unit
- Contains Fibrinogen
- Contains Factors V, VIII, XIII, vWF
- Increases Fibrinogen up to 100 mg/dl per unit dose (15-20 ml per 5-7 kg body weight)
- Indications
- Hypofibrinogenemia (Fibrinogen <100-150 mg/dl)
VIII. Types: Platelets
- See Platelet Transfusion
- Contains 50 ml/unit
- Increases Platelets 30,000/ul to 50,000/ul per 2.0 m2 BSA per 6 pack (one Platelet Apheresis Unit)
- Indications
- Platelet Count <50,000 AND Surgery or childbirth (other cut-offs vary between 10-20,000) OR
- Massive Transfusion Protocol
IX. Adverse Reactions
- See Transfusion Complication
- Hypothermia (warm Blood Products before infusion)
- Hypocalcemia
- Transfusion Reactions